Help, my top HS girl has anemia, 2 weeks to State

physician wrote:

1. Sounds as if there was no history to support this, though severity is often misrepresented

2. Definitely a concern...I'm not sure we talked enough about diet and disordered eating

3. Malabsorption was discussed

This list misses several other causes:

4. Exercise related gastrointestinal bleeding (idiopathic) - would require additional testing and a nuanced understanding of fecal blood testing

5. "March" hemolysis (as previously mentioned) - very common and underdiagnosed in high mileage athletes

6. Atheletics related Cytokine-driven anemia does not fit because it should behave like anemia of chronic inflammation and increase ferritin.

Yeah but none of those are very likely at all, even in runners.

physician wrote:

1. Sounds as if there was no history to support this, though severity is often misrepresented

2. Definitely a concern...I'm not sure we talked enough about diet and disordered eating

3. Malabsorption was discussed

This list misses several other causes:

4. Exercise related gastrointestinal bleeding (idiopathic) - would require additional testing and a nuanced understanding of fecal blood testing

5. "March" hemolysis (as previously mentioned) - very common and underdiagnosed in high mileage athletes

6. Atheletics related Cytokine-driven anemia does not fit because it should behave like anemia of chronic inflammation and increase ferritin.

Also, I don't believe that the OP actually discussed this and whether malabsorption issues were actually tested for.

Any chance of an update OP?

Not OP, but I kept this thread going because of a similar situation to OP with a female HS athlete I coach.

Appreciate having a physician on here!

For our athlete, it doesn't appear to be diet, period, or some underlying medical condition. Kid eats burgers, steak, and chicken all week. No change in weight. Parents have said ferritin was in the 30s so this is not like some of the other threads where single digit numbers require a total shutdown and intensive iron replacement therapy. Maybe 30 is fine, however in our case we are seeing great speed in the athlete but she can't hit her long distance times from the year before and athlete reports feeling tired in long races where she used to feel strong.

Long XC season including nationals, then bumpy indoor season, then early outdoor not going as well as she had hoped for. Workouts are excellent, just having some temporary difficulty with distances over the mile...was thinking it might be iron but who knows. So, of all of the options given I would guess "march hemolysis" because the kid has spent a lot of time running this year. Small breaks here and there but mileage never over 45 miles per week--our program limit. I was wondering if iron pills or liquid might provide an end of season boost so I asked how long it takes to kick in.

With a ferritin of 30, she's on the lower limit of ideal for endurance runners, it certainly wouldn't hurt for her to start taking a supplement (some swear by liquid forms, others do fine on pills). She should feel improvements in a few weeks since she's not technically anemic. This is exactly how my daughter felt at the start of her full blown anemia (she's gluten intolerant and needed infusions to boost her because her tank was empty). Best to get on top of it now, as it took my daughter months to recover. Most female endurance runners could supplement with iron with no issues or concerns of overload, especially if they menstruate regularly.

Disclaimer: I have some medical background in addition to working with a hematologist (who regularly treats female runners). All info I have provided is based on what I have learned and been told by him.

My ferritin was 9. I have celiac disease. I managed to bump it up to the mid 40s in about 6 weeks on one 210mg ferrous fumarate a day. This was before my celiac diagnosis, though my gut was only partly damaged. I guess menstruation must really hit your iron levels as, being a bloke, my iron levels soared straight back up.

Yeah, my daughter's ferritin was 10, and her HGB was 11. She eliminated gluten and started taking oral supplements 3/day, and her numbers were rising. The hematologist suggested the infusions to give her a boost since, in combination with having her periods, it was like filling a tank with a hole in it. Being anemic only made her cycles heavier... it was a vicious cycle, literally. The infusions worked wonderfully well, and she's kept her numbers up with just oral supplements now for over 8 months.

liquid iron in Orange juice will speed it up just be VERY careful... heard elite athletes use this when they are low on iron...

Runners giving medical advice to a coach. Is there something seriously wrong here?

You are all sick and delusional people giving medical advice to a coach who will then give his opinion to a teenager.

OMG you are all seriously messed up individuals.[quote]Gorun wrote:

You're kidding right? Doctors in the UK are hopeless. From what I here, they are even worse in the US

Dr. Marcus Welby wrote:

Runners giving medical advice to a coach. Is there something seriously wrong here?

You are all sick and delusional people giving medical advice to a coach who will then give his opinion to a teenager.

OMG you are all seriously messed up individuals.[quote]Gorun wrote:

Orange juice is fine for the ascorbic acid....Just don't take iron with calcium-fortified orange juice as calcium and other divalent cations (concomitant multivitamin) will impair iron absorption.

Dr. Marcus Welby wrote:

Runners giving medical advice to a coach. Is there something seriously wrong here?

You are all sick and delusional people giving medical advice to a coach who will then give his opinion to a teenager.

OMG you are all seriously messed up individuals.[quote]Gorun wrote:

Is there anything we've suggested that's harmful? We said to have iron levels checked by a doc who is familiar with distance runners, test for celiacs, watch for the female triad, etc. We then suggested tried and true methods of increasing iron levels. Any doctor who understands endurance athletes and the importance of iron levels would suggest the same.

Again, I went through this whole process, as my daughter was quite anemic in the summer and fall. We discovered she is gluten intolerant (stopped consuming gluten), received IV iron preceded and followed by oral supplementation, and is now feeling and running much better. All of this was done under the strict supervision of our hematologist, who often treats endurance athletes.

Not sure what your issue is.

Pics?

OP here with update:

Girl received total of four doses of IV iron over two week period then oral iron for past week. She chose to be announced on the track at State but not run.

Initial lab:

Hematocrit 34

Iron saturation 7%

Ferritin 5

Lab yesterday:

Hematocrit 41

Iron saturation 14%

Ferritin 40

Doc has instructed her to take oral iron everyday then can start soccer workouts and running June 1st. He apparently plans to recheck lab to see if oral iron will maintain her.

Need some help wrote:

She chose to be announced on the track at State but not run.

She's in it for all the wrong reasons, mate.

Need some help wrote:

OP here with update:

Girl received total of four doses of IV iron over two week period then oral iron for past week. She chose to be announced on the track at State but not run.

Initial lab:

Hematocrit 34

Iron saturation 7%

Ferritin 5

Lab yesterday:

Hematocrit 41

Iron saturation 14%

Ferritin 40

Doc has instructed her to take oral iron everyday then can start soccer workouts and running June 1st. He apparently plans to recheck lab to see if oral iron will maintain her.

Levels sound nice and healthy now. She should be alright to slowly increase exercise volume, but keep monitoring levels for a while. Ha, which is basically what you just said. :)